INTRODUCTION:

Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality, occurring in 1% to 2% of the total population and can reach up to 25% in patients (pts) aged 80 years or older referred for TAVI. However, this condition has been excluded from major randomized studies. Recently, international registries with pts with severe symptomatic BAV stenosis who underwent TAVI have shown satisfactory and similar results to tricuspid valves.

OBJECTIVE:

We aimed to investigate the incidence and immediate outcomes of TAVI in pts with BAV in a tertiary, public hospital in Brazil.

METHODS:

Retrospective, single-center, and observational study. We selected all pts who underwent TAVI from November 2020 to January 2023. Clinical and demographic data were collected, and procedure outcomes after TAVI were classified according to VARC 3. Data analysis was performed using descriptive and comparative statistics (Student's t-test) to determine if there are significant differences in outcomes between BAV and tricuspid aortic valve treated pts during the same period.

RESULTS:

Out of a total of 174 pts, 33 (18.9%) had BAV. There is no significant difference between the BAV and tricuspid pts according to mean age (77.6 ± 7.0 y vs 77.6 ± 7.0 y, p=0.98) and STS score (3.50 ± 1.63% vs 3.49 ± 1.62%, p> 0.05), respectively. Balloon expandable valves were used in 30 (90.9%) and 127 (90%) (p=1), in the bicuspid and tricuspid, respectively. Pre-dilation was performed in 25 out of 33 BAV patients (75.7%) and in 71 out of 141 tricuspid pts (50.3%) (p= 0.010). Post-procedure mean gradient were similar (4.98 ± 2.66 vs 5.11 ± 2.66; p> 0.05) for bicuspid and tricuspid, respectively. More than mild paravalvular aortic regurgitation occurred in 10% of pts with BAV and in 2.7% of tricuspid pts (p=0.12). Permanent pacemaker was required in one (3%) case of bicuspid pts and 11 (7.6%) tricuspid (p= 0.47). The procedure was successful in 88%. At 30 days, there was 2 (1.4%) deaths in the tricuspid group vs no death in the bicuspid (p>0.05) and only one (0.7%) stroke in the tricuspid group vs no stroke in bicuspid (p> 0.05).

CONCLUSION:

In our series, TAVI in BAV pts were associated with good clinical outcomes, comparable to tricuspid pts. A higher rate of more than mild paravalvular aortic regurgitation was observed. Additional studies with larger samples are required to confirm these results and provide greater clinical safety for BAV patients undergoing TAVI.